Caninsulin
CaninsulinCaninsulin-Pharmacokinetics, manufactured by Intervet and known in some countries as VetsulinVetsulin Website, is a veterinary porcine lente insulin, made up of 30% semilente (short-acting) and 70% ultralente (long acting) insulins. At present in the US, Caninsulin is FDA-approved for use only in dogs and, just recently, for cats, under the trade name Vetsulin. However, was often used in the US legally "off label" for cats, prior to formal approval.http://www.vetsulin.com/PDF/Vetsulin_Dear_Doctor_Letter.pdf. How it works in dogs The majority of dogs on Caninsulin/Vetsulin (two-thirds) also will require twice-dailyVetsulin Insulin RequirementsCaninsulin-Twice Daily Regimen for Dogs & Cats (Page 6) injections. Intervet says that many dogs stabilize better on twice-daily insulin injections. They also point out that when shots are given twice instead of once daily, there are less hypoglycemia incidents and better blood glucose controlCaninsulin-Starting Insulin in the Healthy Diabetic Patient (Page 4)Effect of Insulin Dosage on GlycemicResponse in Dogs with Diabetes Mellitus: 221 cases (1993-1998)-Journal of the American Veterinary Association-2000. Most vets are also not in favor of once-daily use because it is harder to regulate a dog on once-daily insulin than twice-daily dosingBD Diabetes-Insulin Injections for Dogs. Caninsulin/Vetsulin is a lente insulin, which is classed as intermediate, not long acting. Long acting insulins (such as Lantus,Fleeman & Rand-Comparison of Pharmacodynamics & Pharmacokinetics of Glargine (Lantus), Protamine Zinc (PZI) & Pork Lente in DogsSelecting an Insulin for Treating Diabetes Mellitus in Dogs & Cats-Nelson-OSU Endocrinology Symposium 2006 Page 40 Ultralente, PZI) have a poor success rate among dogs. Canine activity graphs http://www.caninsulin.com/images/insulinactivitydog.jpg For those with dogs, here is a graph of the canine activity. Once-daily vs twice-daily injections This blood glucose graph of Somogyi rebound shows a small dog on once-daily porcine lente injections. You can see how the large insulin dose in once-daily regimens produces a steep low at insulin peak. Note: values are shown in mmol/l (non-US) measurement. http://www.vin.com/ImageDBPub/TN20000/TN_IMC16198_550X0Y.jpg Contrast this with a blood glucose graph with a twice-daily insulin regimen where food and insulin are given on a 12 hour basis. Note: values are shown in mmol/l (non-US) measurement. http://www.vin.com/ImageDBPub/TN20000/TN_IMC16196_550X0Y.jpg How it works in cats Caninsulin works (somewhat differently) in cats than dogs, sometimes having a shorter durationCaninsulin-Page 2. Note feline usage was recently approved by the FDA in the US http://www.vetsulin.com/PDF/Vetsulin_Dear_Doctor_Letter.pdf, and it is a widely prescribed insulin for cats in other countries. Caninsulin is a BID (two times a day) insulinCaninsulin-Twice Daily Regimen in Dogs and Cats (Page 6)Caninsulin-Page 2Caninsulin-Starting Insulin Therapy in the Healthy Diabetic Patient (Page 4). The bg drop experienced by cats can be a concern if not handled correctly. Because of the (sometimes) steep drop, it is important to make food available around the time of nadir to help "smooth" the curve. This can be done either with a timed feeder or free feeding your cat. Though some cats can have good results with Caninsulin, (See the case of Butterscotch at Caninsulin-Vetsulin cases) the typical curve, as reproduced here from the manufacturer's website, is very fast-acting and harsh for the first four hours, and doesn't have the duration necessary for 12-hour dosages. If having poor results and it's at all possible to switch to Levemir, Lantus, or PZI insulin, try to do so. Feline activity graph US scale Int'l scale Further Information It is a veterinary use prescribed insulin and in most countries must either be purchased directly from your vet or with a prescription. In Canada, Caninsulin is available OTC, or over the counterPetPharm.org-Canadian Shipping Only for Caninsulin online. It is also available online with a prescription1800 PetMeds WebsiteBestPet Pharmacy--UK Only in some countries, and may cost less that way. Caninsulin and Vetsulin can be purchased in three ways: a pack of ten 2.5ml vials, the more traditional 10 ml vial or a single vial of 2.5ml. Cats and and small dogs can get new vials monthly without wasting. http://www.intervetusa.com/images/product_photos/VetsulinNew%20frame.jpg http://web.archive.org/web/20051013033250/http://www.intervet.fr/Binaries/71_94832.jpg Vetsulin in ten 2.5ml vial pack and 10ml vial. French Caninsulin syringes. Caninsulin/Vetsulin syringes Because Caninsulin is a U40 insulin, U40 syringes are the most helpful. If you choose to use a U100 syringe, you must do the U40 to U100 conversionFDMB-Using U40 Insulin in a U100 SyringeUsing Caninsulin With a U100 Syringe-Page 2. The conversion is not difficult and can give you precision of 0.2 units for those animals needing a more precise dose. http://pets.intervet.it/binaries/96_104633.jpg Caninsulin/Vetsulin branded syringes do not appear the same world-wide. Above is a photo of Caninsulin syringes sold in Italy; French Caninsulin syringes are shown above. Technical details Caninsulin is a pork-based lente insulin. It is a suspension of crystalline (ultralente) and amorphous (semilente) insulins in a 70/30 ratio, as are all Lente insulinsEMEA Scientific Discussion Monotard.Iletin II LenteUS-FDA Iletin II Lente Discontinuation Material 2003 by Eli Lilly and Monotard Pork by Novo Nordisk were pork lente insulins. The difference between them is: Vetsulin/Caninsulin is made by Intervet for veterinary use and is a U40 strength insulin--the Lilly and Novo insulins were U100 strength. U40 insulin is more convenient for small animals since it's more dilute and you can therefore give fine doses more easily. Caninsulin is an aqueous suspension of insulin containing 40 IU per ml of highly purified porcine insulin (Lente); 30% is amorphousMerck Manual Amorphous Definition (non-crystallized) zinc (Semilente) insulin and 70% crystalline (in crystal form) zinc (Ultralente) insulin. The difference between Caninsulin and both Iletin II LenteIletin II Lente-Lente Pork Insulin Remedyfind.com made by Eli Lilly and Monotard PorkEvaluation of an Insulin Zinc Suspension for Control of naturally Occurring Diabetes Mellitus in Dogs-Australian Veterinary Journal-2000 (Page 3) made by Novo Nordisk is this: Caninsulin/Vetsulin is a veterinary insulin of U40 strength. Both Novo's and Lilly's insulins were U100 strength. Caninsulin contains porcine insulin. Porcine insulin is identical to canine insulinIntervet-Caninsulin-Product Information, but differs from human insulin in respect of one key amino acid. Porcine insulin differs from feline insulin in 3 amino acid positions shown in the table belowAmino Acid Sequences. Human insulins (i.e. Lantus) differ from from feline insulin by all four key amino acids. What Lente Is Not No Lente-type insulin regardless of species can contain any NPH/isophane insulinCombining Lente-type Insulins with Phenol-Preserved Insulins or any R/Neutral insulinLente Zinc Suspension Causes Loss Of R/Neutral Short-Acting EffectAvailability of Soluble (R/Neutral) Insulin in Mixed Preparations With Crystalline (Lente) & Ultralente GE Insulin-Clinical Therapeutics-1991. Both are chemically impossible: the phenol preservative present in NPH/isophane alters the action of Lente-type insulins, creating a mixture with an approximate action of R/NeutralLente-Type Insulins & NPH/Isophane Insulins-A Bad Combination. The zinc suspension of Lente-type insulin binds R/Neutral, causing the short-acting insulin to slow, losing its short-acting effectIntermediate-Acting Insulin Preparations: NPH (Isophane) & Lente Diabetes Care-1980 Note--in 1980, there was only beef Lente-type insulin--no pork or r-DNA/GE/GMLente insulinsResource Guide-2005-American Diabetes Association. Lente-type insulins cannot be dispensed in pen or cartridge form because the glass ball used to mix the insulin in these devices will shatter the Lente crystalsInsulin-Dependent Diabetes--Page 10--Dr. Ragnar Hanas. Combining Lente Family Insulins Insulin manufacturersInsulin Producers vs Doctors Re:Combining R/Neutral & Lente-type Insulins indicate that R/neutral and semilente, Lente, ultralente insulins are able to be combined in the same syringe, but only just before injection. In pre-filled syringes, the zinc suspension of the Lente-type insulins binds the R/neutral, causing it to lose its short-acting effect. Various studies have documented this, and some doctors advise against using R/neutral in the same syringe with the Lente family of insulinsAvailability of Soluble (R/Neutral) Insulin in Mixed Preparations of Crystalline (Lente) & Ultralente GE Insulins-Clinical Therapeutics-1991Absorption Kinetics & Action Profiles-Single Subcutaneous Administration of Human Soluble (R/Neutral) & Lente Insulin-Diabetes Care-1987Delayed Onset of Action of Soluble (R/Neutral) Insulin After Premixing With Lente Insulin Diabetes Research & Clinical Practice-1983RxEd.org-Insulin Therapy-Mixing Precautions. Further Reading *Wiki cases--Feline Caninsulin-Vetsulin users *Pharmacology of a U40 Porcine Lente Insulin Preparation in Diabetic Cats--Journal of Feline Medicine & Surgery-Rand & Martin-2001 *Wiki cases--Canine Caninsulin-Vetsulin users *Efficacy & Safety of a Purified Porcine Insulin Zinc Suspension for Managing Diabetes Mellitus in Dogs-JAVMA-Dr. Laxton, et. al.-2005 *Horn-Mitten study from Australian Veterinary Journal, citing Church's study equating Caninsulin with Monotard Pork, thus the need for two shots a day in dogs. *Australian Veterinary Journal-Drs. Horn & Mitten Respond to Caninsulin Once-Daily Dosing Claims for Dogs *Dog ear infection *Pancreatitis in dogs *Ivermectin for dogs * Caninsulin web site * Vetsulin web site *PetPharm offers Caninsulin as an over the counter (OTC) medication. Their policy is to ship insulin within Canada only with deliveries made by courier. *Best Pet Pharmacy is online and UK-based, serving the UK and Northern Ireland only. As of October 31, 2005, UK law abolished all charges vets could make for writing prescriptions so one could possibly obtain medications cheaper elsewhere. All insulins in the UK are considered POM--prescription-only medicationsList of POM Veterinary MedicationsCurrent Veterinary POM Medications-UKDTI-UK-Page 3. Abolition of the fees for writing prescriptions makes it possible to obtain one and then shop with them online. *Use in rabbits Though not licensed/approved for use in rabbits, Intervet presents some helpful information on using Caninsulin/Vetsulin for them. *Click Here For Photo of Caninsulin Syringe With Magnifier *Intervet UK-Caninsulin Product Data Sheet *OSU Endocrinology Symposium 2006-Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Nelson-Page 39 *Better Medicine-E-Newsletter-June 2006 References Category:InsulinsCategory:intermediate-actingCategory:Lente Category:VeterinaryCategory:porcineCategory:Rx StatusCategory:OTC StatusCategory:MethylparabenCategory:ZincCategory:Acetate